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LETTER TO EDITOR
Year : 2014  |  Volume : 29  |  Issue : 1  |  Page : 57-58  

Rare case of extradural spinal metastasis from primary lung malignant melanoma detected with fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography


1 Departments of Nuclear Medicine and Positron Emission Tomography and Computerized Tomography, Kovai Medical centre and Hospital Limited, Coimbatore, Tamil Nadu, India
2 Department of Oncology, Comprehensive Cancer Care Centre, Kovai Medical centre and Hospital Limited, Coimbatore, Tamil Nadu, India
3 Department of Neurosurgery, Comprehensive Cancer Care Centre, Kovai Medical centre and Hospital Limited, Coimbatore, Tamil Nadu, India
4 Department of Pathology, Comprehensive Cancer Care Centre, Kovai Medical centre and Hospital Limited, Coimbatore, Tamil Nadu, India

Date of Web Publication24-Jan-2014

Correspondence Address:
Koramadai Karuppusamy Kamaleshwaran
MD (Nuclear Medicine), Department of Nuclear Medicine, Positron Emission Tomography and Computerized Tomography and Radionuclide therapy, Comprehensive Cancer Care Centre, Kovai Medical centre and Hospital Limited, Coimbatore - 641 014, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-3919.125782

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How to cite this article:
Kamaleshwaran KK, Natarajan S, Parthiban J, Mehta S, Radhakrishnan K, Shinto AS. Rare case of extradural spinal metastasis from primary lung malignant melanoma detected with fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography. Indian J Nucl Med 2014;29:57-8

How to cite this URL:
Kamaleshwaran KK, Natarajan S, Parthiban J, Mehta S, Radhakrishnan K, Shinto AS. Rare case of extradural spinal metastasis from primary lung malignant melanoma detected with fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography. Indian J Nucl Med [serial online] 2014 [cited 2019 Dec 8];29:57-8. Available from: http://www.ijnm.in/text.asp?2014/29/1/57/125782

Sir,

Primary malignant melanoma (MM) of the lung is a very rare neoplasm, accounting for 0.01% of all lung tumors. [1],[2] Prompt evaluation and close follow-up of the patient is proposed in order to diagnose metastatic dissemination and to improve outcome. [3] There are no previous reports of fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography (F-18 FDG PET/CT) in patients with extradural metastasis from primary lung melanoma. Here, we report a rare case of extradural spinal metastasis from primary lung MM during restaging seen in FDG PET/CT. A 56-year-old male patient diagnosed as primary melanoma of lung underwent pneumonectomy and radiotherapy a year before. He presented with the neck pain and was referred for the whole body PET/CT to rule out metastasis. Restaging PET/CT revealed intense uptake in the extradural lesion in C4-C6 vertebral level and no other sites of metastasis [Figure 1]. Lesion was excised which was confirmed pathologically as metastasis from melanoma [Figure 2].
Figure 1: Sagittal fused positron emission tomography/computed tomography (PET/CT) (a) and CT (b); axial fused PET/CT (c) and CT (d); and maximum intensity projection image (e) of whole body fluorodeoxyglucose-PET/CT showing intense uptake (arrows) in the extradural mass C4-C6 vertebra level. There were no other lesions to suggest malignancy in the whole-body PET image

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Figure 2: Histopathological microphotographs (hematoxylin and eosin staining) revealed a highly cellular malignant tumor with prominent nucleoli (image a, ×100; image b, ×400). Immunohistochemical study shows that the tumor cells stained diffusely positive for HMB-45 (image c) and Melan-A (image d), consistent with the diagnosis of melanoma

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Gokaslan et al.,[4] reported 133 cases of vertebral metastatic melanoma over a period of 11 years and Ishii et al.,[5] reviewed reports of nine cases of intramedullary spinal cord metastatic melanoma. In the present case, the metastatic melanoma was located in the extradural space of the spinal canal and the metastasis was detected 1 year after the lung melanoma resection. PET/CT imaging has been shown to be superior to conventional imaging methods in patients with high-risk melanoma. Gadolinium-enhanced magnetic resonance imaging (MRI) is highly sensitive in the detection of intra- and extramedullary spinal neoplasms, but the MRI field of view is limited. An advantage of PET or PET/CT is that it offers a whole body technique that allows the detection of distant metastases anywhere in the body including the neural axis. [6],[7],[8] There is only one previous report by Lee et al.,[9] involving F-18 PET/CT and primary malignant melanoma in a spinal cord root and MRI of the patient revealed an enhanced mass in the intra- and extradural space compressing the spinal cord at the left neural foramen at the C6-C7 level. There have been no reports involving F-18 FDG PET/CT and extradural metastasis from primary lung melanoma. The present case, to the best of our knowledge, is the first description of a case of extradural spinal metastases from melanoma of the lung which was picked up on the basis of a restaging PET/CT scan.

 
   References Top

1.Wilson RW, Moran CA. Primary melanoma of the lung: A clinicopathologic and immunohistochemical study of eight cases. Am J Surg Pathol 1997;21:1196-202.  Back to cited text no. 1
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2.Ost D, Joseph C, Sogoloff H, Melezes G. Primary pulmonary melanoma: Case report and literature review. Mayo Clin Proc 1999;74:62-6.  Back to cited text no. 2
    
3.Reed RJ III, Kent EM. Solitary pulmonary melanomas: Two case reports. J Thorac Cardiovasc Surg 1964;48:226-31.  Back to cited text no. 3
    
4.Gokaslan ZL, Aladag MA, Ellerhorst JA. Melanoma metastatic to the spine: A review of 133 cases. Melanoma Res 2000;10:78-80.  Back to cited text no. 4
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5.Ishii T, Terao T, Komine K, Abe T. Intramedullary spinal cord metastases of malignant melanoma: An autopsy case report and review of the literature. Clin Neuropathol 2010;29:334-40.  Back to cited text no. 5
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6.Eigtved A, Andersson AP, Dahlstrom K, Rabøl A, Jensen M, Holm S, et al. Use of fluorine-18 fluorodeoxyglucose positron emission tomographyin the detection of silent metastases from malignant melanoma. Eur J Nucl Med 2000;27:70-5.  Back to cited text no. 6
    
7.Gulec SA, Faries MB, Lee CC, Kirgan D, Glass C, Morton DL, et al. The role of fluorine-18 deoxyglucose positron emissiontomography in the management of patients with metastatic melanoma: Impact on surgical decision making. Clin Nucl Med 2003;28:961-5.  Back to cited text no. 7
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8.Swetter SM, Carroll LA, Johnson DL, Segall GM. Positron emission tomography is superior to computed tomography for metastatic detection in melanoma patients. Ann Surg Oncol 2002;9:646-53.  Back to cited text no. 8
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9.Lee NK, Lee BH, Hwang YJ, Sohn MJ, Chang S, Kim YH, et al. Findings from CT, MRI, and PET/CT of a primary malignant melanoma arising in a spinal nerve root. Eur Spine J 2010;19 Suppl 2:S174-8.  Back to cited text no. 9
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